Background: Intraoperative mapping techniques maximize safety and efficacy during perirolandic glioma resection but may induce seizures and limit the procedure. We aim to report the incidence and predictors of stimulation-induced seizures during mapping either patient is awake or under general anesthesia (GA).Methods: Retrospective analysis of 64 patients (40 awake and 24 GA) with perirolandic glioma underwent resection using intraoperative mapping techniques between 2014 and 2019. Preoperative data, operative details, postoperative neurological status, and extent of resection (EOR) were analyzed. Predictors of intraoperative seizures were assessed.Results: The mean cortical and subcortical stimulation intensities needed to evoke motor responses were significantly lower in awake cases than in GA patients (4.9 ± 0.42 vs. 8.9 ± 1.2 mA) and (8.3 ± 0.62 vs. 12.1 ± 1.1 mA), respectively (P= 0.01). Incidence of intraoperative seizures was lower but statistically non-significant in awake cases (10% vs. 12.5%) (P= 0.76). Preoperative multiple antiepileptic drugs (AEDs) (P= 0.03) and low-grade glioma (P= 0.04) were statistically significant predictors for intraoperative seizures. Mean EOR in awake cases was 92.03% and 90.05% in GA cases (P= 0.23). Postoperative deficits were permanent after 3 months only in 5% of awake patients versus 8.3% of GA group (P= 0.59).Conclusion: Awake craniotomy with intraoperative mapping can be done safely for perirolandic gliomas with lower but statistically nonsignificant incidence of intraoperative seizures and this could be attributed to statistically significant lower stimulation intensities required for mapping. Preoperative multiple AEDs and low-grade glioma are significant predictors for intraoperative seizures.

Background: Multidisciplinary pre-surgical evaluation is vital for epilepsy surgery decision and outcomes. Resective epilepsy surgery with assisted monitoring is currently a standard treatment for focal drug resistant epilepsy (DRE). In resource-limited countries, lack of epilepsy surgery center is a huge challenge. We presented and illustrated how to create a multidisciplinary protocol with resource-limited settings in a developing country and epilepsy surgery outcome using brain mapping and monitoring techniques for ensuring satisfactory resection. Methods: We created multicentric incomplete but complementary units covering all epilepsy-related sub-specialties and covering a wide geographical area in our country. Then, we conducted a prospective and multicentric study with low resource settings on patients with focal DRE, who underwent resective epilepsy surgery and were followed up for at least 12 months and were evaluated for postoperative seizure outcome and complications if present. Preoperative comprehensive clinical, neurophysiological, neuropsychological, and radiological evaluations were performed by multidisciplinary epilepsy team. Intraoperative brain mapping including awake craniotomy and direct stimulation techniques, neurophysiological monitoring, and electrocorticography was carried out during surgical resection. Results: The study included 47 patients (18 females and 29 males) with mean age 20.4 ± 10.02 years. Twenty-two (46.8%) patients were temporal epilepsy while 25 (53.2%) were extra-temporal epilepsy. The epilepsy surgery outcome at the last follow up was Engel Class I (seizure free) in 35 (74.5%), Class II (almost seizure free) in 8 (17%), Class III (worthwhile improvement) in 3 (6.4%), and Class IV (no worthwhile improvement) in 1 patient (2.1%). Conclusion: With low resource settings and lack of single fully equipped epilepsy center, favorable outcomes after resective surgery in patients with focal DRE could be achieved using careful presurgical multidisciplinary selection, especially with using intraoperative brain mapping and electrocorticography techniques.

Gliomas are a type of brain tumor that requires accurate monitoring for progression following surgery. The Brain Tumor Reporting and Data System (BT-RADS) has emerged as a potential tool for improving diagnostic accuracy and reducing the need for repeated operations. This prospective multicenter study aimed to evaluate the diagnostic accuracy and reliability of BT-RADS in predicting tumor progression (TP) in postoperative glioma patients and evaluate its acceptance in clinical practice. The study enrolled patients with a history of partial or complete resection of high-grade glioma. All patients underwent two consecutive follow-up brain MRI examinations. Five neuroradiologists independently evaluated the MRI examinations using the BT-RADS. The diagnostic accuracy of the BT-RADS for predicting TP was calculated using histopathology after reoperation and clinical and imaging follow-up as reference standards. Reliability based on inter-reader agreement (IRA) was assessed using kappa statistics. Reader acceptance was evaluated using a short survey. The final analysis included 73 patients (male, 67.1%; female, 32.9%; mean age, 43.2 ± 12.9 years; age range, 31–67 years); 47.9% showed TP, and 52.1% showed no TP. According to readers, TP was observed in 25–41.7% of BT-3a, 61.5–88.9% of BT-3b, 75–90.9% of BT-3c, and 91.7–100% of BT-RADS-4. Considering >BT-RADS-3a as a cutoff value for TP, the sensitivity, specificity, and accuracy of the BT-RADS were 68.6–85.7%, 84.2–92.1%, and 78.1–86.3%, respectively, according to the reader. The overall IRA was good (κ = 0.75) for the final BT-RADS classification and very good for detecting new lesions (κ = 0.89). The readers completely agreed with the statement “the application of the BT-RADS should be encouraged” (score = 25). The BT-RADS has good diagnostic accuracy and reliability for predicting TP in postoperative glioma patients. However, BT-RADS 3 needs further improvements to increase its diagnostic accuracy.

Background: Colloid cysts are considered rare benign tumors at the 3rd ventricle. Best surgical option for such tumors has not been established, however endoscopic approaches have been gaining popularity and have been proved to be an effective modality. We aimed to assess surgical outcomes of endoscopic resection of colloid cysts with evaluation of extent of resection and rate of complications.Materials and methods: A retrospective cohort study was conducted to investigate surgical outcomes of patients who had undergone endoscopic resection of colloid cyst. Pre-operative clinical and radiological data were collected. Operative details, extent of resection and postoperative complications were estimated.Results: In this study 27 cases had undergone endoscopic resection of colloid cyst in the period from January 2016 to January 2021. Patients were of mean age 32.7±10.9 years (17 patients were males). Headache was the most common presentation in (81.5%) of our patients. Complete resection was reported in 22 cases (81.5%), while subtotal resection with coagulation of residual adherent parts was done in 5 cases (18.5%).3 patients (11.1%) had postoperative wound infection, 2 patients (7.4%) experienced postoperative transient memory deficits, and only one patient (3.7%) had postoperative fulminant meningitis, and this was our mortality case. EVD was inserted in 9 patients (33.3%), but only 2 patients (7.4%) who further had a permanent VP shunt.Conclusion: Endoscopic resection of 3rd ventricle colloid cysts is an effective procedure that provides gross total resection in most patients and has lower morbidity and mortality rates.

Background Cranioplasty is performed after decompressive craniectomy (DC) mainly for protection of the brain and cosmetic purposes. Furthermore, cranioplasty may also improve neuronal and cognitive functions. Despite cranioplasty is a common procedure, the proper timing for cranioplasty is still debatable. Purpose:This study aims at evaluating the impact of timing of cranioplasty after DC on functional and surgical outcomes. Material and methodsThis retrospective study included patients who underwent cranioplasty after DC for severe traumatic brain injury. Patients were divided into two groups based on the time to cranioplasty, either within 2 months (early group) or after 2 months from the initial DC (late group). Patients’ demographics, operative details, postoperative complications, and neurological status at the final visit were collected. Disability Rating Scale (DRS) and Glasgow outcome score (GOS) were used to evaluate the functional outcome.ResultsSixty-two patients were included in this study ,44 males and 18 females, and the mean age was (33.2±15.1). 36 patients (58.1%) were included in the late group, while 26 patients (41.9%) were in the early group. The mean GOS was higher in the early group but wasn’t statistically significant (3.85 ±0.35 vs 3.56 ±0.30; P = 0.12), also there was no statistically significant difference in the DRS between early and late groups (8.85 ±2.05 vs 9.5 ±1.93; P = 0.33). Regarding complications of cranioplasty, there was insignificant difference between the two groups.conclusion Early cranioplasty can be done safely without higher rates of complications, and it may carry better neurological and functional outcomes.